| Privacy Policy |

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Evergreen Solutions, LLC

Notice of Privacy Practices

Effective Date: 09/09/2024

This Notice describes how your health information may be used and disclosed, and how you can access your information, as required by the Health Insurance Portability and Accountability Act (HIPAA) and federal regulations under 45 CFR Parts 160 and 164. Please review this carefully.

I. Our Responsibilities and Commitment to Your Privacy

Evergreen Solutions, LLC ("the Agency") is legally required to:

         - Maintain the confidentiality of your protected health information (PHI)

         - Inform you of our legal duties and privacy practices through this Notice

         - Comply with the terms of this Notice while it is in effect

         - Provide updated versions of this Notice when changes are made, which will apply to all PHI   

           we maintain

This Notice applies to records related to your mental health care, created or maintained by the Agency. A record of your care is necessary for treatment, legal compliance, and continuity of services.

II. How Your Health Information May Be Used and Shared Without Authorization

Your PHI may be used or disclosed without your written authorization in the following situations:

1. Treatment (45 CFR § 164.506)

We may use or share your PHI with other healthcare professionals involved in your care. This includes:

         - Consulting with another therapist or specialist

         - Coordinating care with a primary care provider or psychiatrist

         - Referrals to other professionals

         - Disclosures for treatment may involve your full record when necessary to ensure accurate and 

            effective care.

2. Payment

We may use your information to:

         - Process insurance claims

         - Confirm eligibility or benefits

         - Send invoices or receipts

You may request restrictions on these disclosures, particularly if you pay your agreed rate in full out-of-pocket (see Section V).

3. Health Care Operations

PHI may be used for internal business functions, including:

         - Quality assessment and improvement activities

         - Clinical supervision or training

         - Licensing or credentialing processes

         - Audits or legal reviews

4. When Required by Law (45 CFR § 164.512(a))

We may disclose PHI without your permission when required to comply with federal, state, or local laws. For example:

         - Reporting suspected child, elder, or dependent adult abuse

         - Responding to a court order or subpoena

         - Complying with mandatory public health reporting

5. To Prevent a Serious Threat to Health or Safety (45 CFR § 164.512(j))

We may disclose PHI to prevent or lessen a serious and imminent threat to the health or safety of you, another person, or the public.

6. Health Oversight Activities (45 CFR § 164.512(d))

PHI may be shared with government agencies responsible for monitoring the healthcare system, licensing professionals, or enforcing civil rights laws.

7. Judicial or Administrative Proceedings

We may disclose PHI if required for legal proceedings. When possible, we will notify you before sharing information in response to a subpoena or discovery request.

8. Law Enforcement (45 CFR § 164.512(f))

In limited situations, PHI may be disclosed to law enforcement, such as:

         - Reporting certain crimes committed on the premises

         - In response to a court order or warrant

         - When required by law

9. Coroners and Medical Examiners

PHI may be provided to identify a deceased person or determine the cause of death as authorized by law.

10. Workers’ Compensation (45 CFR § 164.512(l))

PHI may be disclosed to comply with workers’ compensation laws or similar programs providing benefits for work-related injuries.

11. National Security and Government Functions

Disclosures may be made to authorized federal officials for national security or protective services under federal law.

12. Business Associates (45 CFR § 164.502(e))

We may share PHI with third-party service providers (e.g., billing, scheduling, record storage) under written contracts requiring HIPAA compliance.

III. Uses and Disclosures That Require Your Written Authorization

Your written permission is required for the following:

1. Psychotherapy Notes (45 CFR § 164.508(a)(2))

Psychotherapy notes are kept separate from your clinical record and contain personal reflections by your provider. These may not be shared without your written authorization, except:

         - For treatment or supervision by your provider

         - For legal defense if you file a complaint or lawsuit

         - As required by law (e.g., audits, safety concerns)

2. Marketing

Your PHI will not be used for marketing communications without your express written consent.

3. Sale of PHI

Evergreen Solutions does not and will not sell your PHI.

You may revoke your authorization at any time in writing. Revocation does not apply to any actions already taken.

IV. Uses and Disclosures Requiring Opportunity to Object

Unless you object, PHI may be shared with:

         - A family member or person involved in your care 

         - An emergency contact, if needed to coordinate care or ensure your safety

         - If you are unable to agree or object (e.g., due to incapacity), the provider may use 

           professional judgment.

V. Your Rights Regarding Protected Health Information

You have the following rights under HIPAA:

1. Right to Access Your Records (45 CFR § 164.524)

You may request a copy of your records in paper or electronic form. Requests will be fulfilled within 30 days. A reasonable, cost-based fee may apply.

2. Right to Request Amendments (45 CFR § 164.526)

You may request corrections to your PHI if you believe it is incorrect or incomplete. We may deny your request with written explanation.

3. Right to Confidential Communication (45 CFR § 164.522(b))

You may request that we contact you in a specific way (e.g., email, phone) or at a specific address.

4. Right to Request Restrictions (45 CFR § 164.522(a))

You may request limitations on how your PHI is used or disclosed. While we are not required to agree, we will honor requests not to share information with a health plan if you pay for services in full.

5. Right to Accounting of Disclosures (45 CFR § 164.528)

You may request a list of non-routine disclosures (e.g., those not related to treatment, payment, or operations) from the past six years. The first request per year is free.

6. Right to a Copy of This Notice (45 CFR § 164.520(c))

You may request a paper or electronic copy of this Notice at any time.

7. Right to Designate a Personal Representative

A person with legal authority (e.g., guardian, medical power of attorney) may exercise your rights on your behalf.

8. Right to File a Complaint

If you believe your rights have been violated, you may file a complaint without fear of retaliation:

           Evergreen Solutions, LLC

           Attn: Lauren Holloway, LCSW

           2222 W. Grand River Ave, STE A

           Okemos, MI 48864

           Phone: (810) 214-4124

You may also file a complaint with the U.S. Department of Health and Human Services:

           Office for Civil Rights

           200 Independence Ave. SW

           Washington, D.C. 20201

           Phone: 1-877-696-6775

           Website: www.hhs.gov/hipaa/filing-a-complaint